Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Positions in this function require RN licensure with current unrestricted licensure in applicable state, and may require certification based on role and grade level. Provides clinical support for performing clinical review of appeals, and may also review quality of service issues. Process includes analyzing, reviewing and evaluating appeals in compliance with state and federally mandated turn-around-times and process requirements. *Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.

Primary Responsibilities:

• Provides clinical support for performing clinical review of appeals and may also review quality of service issues. Process includes analyzing, reviewing and evaluating appeals in compliance with state and federally mandated turn-around-times and process requirements
• Basic, structured, standard approach to work
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• PHRN with active license
• 3+ years Critical Care Experience
• Proven excellent communication skills, both orally and in writing
• PHRN who possesses solid medical/clinical knowledge to interpret available medical information
• Must be willing to work onsite

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone - of every race, gender, sexuality, age, location and income - deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Optum is a drug-free workplace. © 2025 Optum Global Solutions (Philippines) Inc. All rights reserved.